Why Your Chances for Surviving Serious Injury Just Fell By 25%

More than 50 million Americans experienced a medically treated injury in 2000, resulting in lifetime costs of $406 billion: $80 billion for medical treatment and $326 billion for lost productivity. According to the CDC-funded National Study on the Costs and Outcomes of Trauma, the risk for death of a severely injured person is 25% lower if the patient receives care at a Level I trauma center vs. at a non-trauma center. Whether you live or die after being seriously injured is largely dependent on the level of split-second decision-making skill that your EMS provider and/or doctor possesses. At the scene of an injury, Emergency Medical Service (EMS) providers must identify the severity and type of injury, and determine which hospital or other facility would be the most appropriate to meet the needs of the patient. This is done through a process called “field triage.”

As they are the “tip of the spear” when it comes to affecting positive serious injury healthcare outcomes, we all have a vested interest in making sure that EMS responders make the most intuitive yet predictable decisions while in the field.

In 2004, the number of emergency department visits for nonfatal injuries exceeded 41 million, and more than 6.5 million injured patients (16%) were transported by ambulance. Effective field triage has the most direct impact on how many of those 6.5 million lives will be routed to the correct treatment facility.

In an attempt to standardize the emergency field triage decision process, the American College of Surgeons developed the Field Triage Decision Scheme(Decision Scheme), which serves as the basis for triage protocols for state and local EMS systems across the United States. Created in 1986, the Decision Scheme is an algorithm that guides EMS providers through four decision steps (physiologic, anatomic, mechanism of injury, and special considerations) to determine the most appropriate destination facility within the local trauma care system. Injured persons treated in emergency departments in 2000 accounted for $99 billion (24%) of the total cost of injury, with $32 billion in medical costs and $68 billion in productivity losses.

There are three specific field triage problems that the Decision Scheme seeks to address:

  1. Overtriage, which results in higher healthcare costs and wasted human resources. A review of data concerning ten terrorist bombings demonstrated a direct linear relationship between the rate of overtriage and the mortality rate of those critically injured.
  2. Since 1993, the number of hospitals with trained trauma centers has decreased significantly. When an ambulance transports a patient with minor injuries unnecessarily to a Level I trauma center thirty miles away instead of to a community hospital five miles away, the trauma center may have too few resources available to effectively respond to a real emergency.
  3. Non-emergency patient visits to trauma centers continue to rise. Many of these patients are uninsured. This issue is further complicated when you combine inadequate reimbursement from payers along with rising insurance costs.

Most of us have been witness to tragic events that involved the injury of people that we cared about. Typically the first person we interact with in those stressful situations is the EMS professional who assesses the situation and recommends a certain course of action. We all want our healthcare to come with maximum quality and reasonable costs. At the end of the day there are only two answers to two very important questions that matter.

How do we make sure that every treatment decision made during field triage is the correct one and, assuming perfection is not an option, how do we correct the error in time for it to matter?

What are your thoughts?


  1. The CDC-funded National Study on the Costs and Outcomes of Trauma.
  2. The Centers for Disease Control and Prevention (CDC) partnered with the National Highway Traffic Safety Administration and the American College of Surgeons to publish the “Guidelines for Field Triage of Injured Patients.”
  3. Accurate Field Triage of Injured Patients Saves Lives and Money.

How Healthcare “Meaningful Use” Will Change Your Life (Someday)

In my previous article, “What is ‘Meaningful Use’ and Why is it Such a Big F*cking Deal?” I discussed the reasons why the Health Information Technology for Economic and Clinical Health Act (HITECH) was passed. Now that we’ve covered the always less exciting “origin” episode of this movie trilogy, let’s move on to the exciting sequel. In part II, we continue the conversation by laying out the benefits that both doctors and patients can expect to receive once electronic health record (EHR) programs are implemented nationally.

Benefits Doctors Can Expect From Leveraging Electronic Health Records

Doctors can qualify for Medicare meaningful use incentives in stages over five years that can add up to $44,000 per physician. Hospitals’ incentive terms can vary, but they start with a $2 million base payment. In February 2012 (the month for which the latest data is available), 12,365 physicians and other “eligible professionals” received $222.6 million in Medicare meaningful use incentives, compared with 84 hospitals getting $129.9 million, according to an April 5 report delivered to MedPAC.

The goal of the EHRs and health information exchange is to help clinicians provide higher quality and safer care for their patients. When it comes to rubber meeting road, the long-term success of this program rests squarely in the hands of your friendly neighborhood clinician. She must be properly motivated and equipped with the tools necessary to make the transition as smooth as possible. In exchange for this effort most physicians can expect to gain access to the following benefits:

  • Ability to approximate the look and feel of a family practice while also increasing their capacity to serve more patients. Having access to a summary of comprehensive patient information will allow doctors to quickly focus on a likely diagnosis while also demonstrating broad knowledge of patients’ history.
  • Ability to ask for and conduct real-time clinical consultations with colleagues all over the world. First, second, and third opinions can be collected, reviewed, and documented almost instantaneously. Since no physician needs to step out on a lonely limb to make a tough decision, treatments can be executed much faster and with less fear of reprisal.
  • Increasing bottom-line revenue as a direct consequence of the last two benefits. It follows that if you can improve the relationship you have with your patients while also increasing the number of patients you can serve—in the midst of also improving the overall quality of care being provided—you will increase revenue and decrease costs.

Benefits Patients Can Expect From Leveraging Electronic Health Records

Electronic health records make it possible for the average consumer and his or her doctors to better manage care through secure use and sharing of health information. Patients will likely see the following benefits:

  • It won’t matter as much which doctor you choose to see because the quality will be the same. Seeing a specific doctor will be less important as all clinicians will have instantaneous access to your prior history and treatment. Quality and continuity will be maintained throughout since everyone will have access to the same playbook.
  • It will make it easier for families to act as a unified healthcare support group. Electronic records will make is possible for every family member to be actively involved in supporting the overall healthcare needs of the group. Everyone becomes accountable for both the group and individual decisions that can either lead to an overall improvement in health, or be a contributor to actions that can lead to negative healthcare outcomes.
  • Access to better-informed doctors who commit fewer medical errors while increasing quality will lead to lower patient costs. If you as a patient have greater access to custom preventative treatments based on your history, get fewer unnecessary lab tests performed, receive fewer prescribed medications, experience shorter hospital stays, and don’t need as much ongoing outpatient treatment, the chances are pretty good that both your costs and the costs incurred by your clinician will shrink significantly during the course of your treatment.

Bringing doctors closer to patients in ways that increase the quality of care and reduce operating costs is the key target outcome for HITECH. Do you believe that the benefits that come with deploying an effective EHR program will outweigh the costs? What benefits have you seen or do you expect to see from implementing your EHR program?


  1. CAUSATUM Blog: http://causatumblog.com/2012/07/what-is-meaningful-use-and-why-is-it-such-a-big-fcking-deal/
  2. “More Physicians Awarded Meaningful Use Money,” Pamela Lewis Dawson, American Medical News, April 19, 2012: http://www.amaassn.org/amednews/m/2012/04/16/bsf0419.htm
  3. The Office of the National Coordinator for Health Information Technology: http://healthit.hhs.gov/portal/server.pt?open=512&objID=2996&mode=2


What is “Meaningful Use” and Why is it Such a Big F*cking Deal?

If you are not a doctor or you don’t run a major hospital, you may not have heard the terms “meaningful use” or “electronic health records (EHRs).” But if you have ever been in an emergency room filling out paperwork while anxiously waiting to see a doctor, or if you or a family member has ever had to deal with a complex illness whose treatment involves teams of doctors and multiple treatments, you should make it your business to know.

One of the main goals of “meaningful use” is to make sure that no matter what hospital you visit or what doctor you choose to see, everyone that matters will be able to make informed treatment decisions based on transparent access to your medical history. But anyone vaguely familiar with the American healthcare system understands that this is easier said than done. This is the first article of a three-part series that will discuss the rationale behind “meaningful use,” the expected benefits to both patients and healthcare institutions, and the progress we have made in rolling this program out nationally.

Although some healthcare institutions have begun digitizing their health records, efforts to coordinate on a national level have historically been met with much structural and political resistance. In 2009, in a decision designed to move things forward, congress passed the Health Information Technology for Economic and Clinical Health Act (HITECH). It marked the first time that billions of dollars were set aside to fund tangible Medicare and Medicaid incentives that will motivate healthcare organizations and physicians to implement electronic health record programs and meaningful use protocols ASAP.

In order to qualify for these million dollar incentives, eligible health care professionals and hospitals must adopt certified EHR technology and use it to achieve specified objectives. More specifically, HITECH has offered up two regulations, one of which defines the “meaningful use” objectives that providers must meet to qualify for the bonus payments, and the other which identifies the technical capabilities required for certified EHR technology.

It takes a good bit of coordination to implement and manage such an ambitious plan on a national level. The Office of the National Coordinator for Health Information Technology (ONC), the Centers for Medicare & Medicaid Services (CMS), and other Health and Human Services agencies are primarily responsible for making all of this happen. They must all work together to execute the following program measures:

  • Creating regional extension centers (RECs) to support providers in adopting EHRs
  • Developing workforce training programs
  • Identifying “beacon communities” that lead the way in adoption and use of EHRs
  • Developing capabilities for information exchange, including building toward a nationwide health information network
  • Improving privacy and security provisions of federal law to bolster protection for electronic records
  • Creating a process to certify EHR technology so providers can be assured that the EHR technology they acquire will perform as needed
  • Identifying standards for certification of products tied to the “meaningful use” of EHRs
  • Identifying the “meaningful use” objectives that providers must demonstrate to qualify for incentive payments

The carrot and stick approach that HITECH is putting forward has two goals in mind: Establish a reliable national standard for physician quality care and give patients control and visibility over their overall healthcare experience. Given the heavy outcome measures that are inserted throughout the implementation process, it won’t be long before we can judge their success on either target.


  1. The Office of the National Coordinator for Health Information Technology: http://healthit.hhs.gov/portal/server.pt?open=512&objID=2996&mode=2
  2. The New England Journal of Medicine: “The ‘Meaningful Use’ Regulation for Electronic Health Records,” David Blumenthal, M.D., M.P.P., and Marilyn Tavenner, R.N., M.H.A., August 5, 2010: http://www.nejm.org/doi/full/10.1056/NEJMp1006114#t=article
  3. Centers for Medicare & Medicaid Services Office of Public Affairs: “Electronic Health Records at a Glance,” July 13, 2010: http://www.cms.gov/apps/media/press/factsheet.asp?Counter=3788&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date